Citation Nr: 9917204
Decision Date: 06/22/99 Archive Date: 06/29/99
DOCKET NO. 96-40 523 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Detroit,
Michigan
THE ISSUE
Entitlement to service connection for post-traumatic stress
disorder.
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
A. Hinton, Associate Counsel
INTRODUCTION
The veteran had active service from December 1967 to December
1969.
This matter comes before the Board of Veterans' Appeals
(Board) on appeal from a May 1996 decision of the Department
of Veterans Affairs (VA) Regional Office (RO) in Detroit,
Michigan. The Board remanded the case for additional
development in February 1998.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable
determination of the veteran's claim has been obtained by the
RO.
2. The veteran currently does not have a PTSD diagnosis.
CONCLUSION OF LAW
PTSD was not incurred during the veteran's active military
service. 38 U.S.C.A. §§ 1110, 5107(a) (West 1991); 38 C.F.R.
§§ 3.303, 3.304(f) (1998).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
The veteran has claimed entitlement to service connection for
post-traumatic stress disorder (PTSD). As a preliminary
matter, the Board finds that the veteran's claim is "well-
grounded" within the meaning of 38 U.S.C.A. § 5107(a). See
Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990); Gilbert v.
Derwinski, 1 Vet. App. 49, 55 (1990). That is, the Board
finds that the veteran has presented a claim which is not
implausible when his contentions and the evidence of record
are viewed in the light most favorable to the claim. The
Board is also satisfied that all relevant facts have been
properly and sufficiently developed. Accordingly, no further
assistance to the veteran is required to comply with the duty
to assist mandated by 38 U.S.C.A. § 5107(a).
The veteran's service medical records show treatment for a
shrapnel wound of the upper right leg. Service medical
records do not show any records referable to a psychiatric
disorder. At his November 1969 discharge examination, the
veteran made no complaints referable to a psychiatric
disorder. His psychiatric evaluation at that time was
normal. His service administrative records show that he
served in Vietnam as a field artillery crewman, and that his
decorations include a Vietnam Service Medal and a Vietnam
Campaign Medal. He was also awarded the Purple Heart.
Post service VA medical records and examination reports,
dated from 1992 to 1998 are of record. These records reflect
the veteran's complaints of depression, nervousness,
flashbacks, nightmares, anger, irritability, hallucinations
and insomnia. These records also reflect varying psychiatric
diagnoses that included alcohol abuse and dependence,
marijuana abuse and dependence, PTSD, and a depressive
disorder, not otherwise specified, secondary to long history
of alcohol dependence and continuous marijuana abuse.
VA clinical records show that the veteran was hospitalized
from August to October 1992, after being admitted in an
acutely intoxicated condition. The hospital report noted
that the veteran reported that he had a history of PTSD,
although his description of the symptoms were not well
understood. The diagnoses at that time were alcohol
intoxication, alcohol dependence, and PTSD "X". During the
course of hospitalization, he underwent an uneventful
detoxification and was treated to help control nervousness.
The report noted that after he spent more time away from
alcohol, he was much better psychologically and physically.
He underwent counseling and group psychotherapy to address
some anger and stress problems. His exit status was noted to
be improved and without evidence of drug or alcohol use, or
homicidal or suicidal ideation.
In a January 1993 award determination, the Social Security
Administration (SSA), found that current medical evidence
established that since April 1990, the veteran had had a
severe substance addiction disorder, depression, post-
traumatic stress disorder, and a personality disorder.
The report of an October 1995 VA examination for mental
disorders noted reported difficulties with drinking. On
mental status examination, the veteran complained of having
flashbacks, nightmares, depression, irritability and anger.
His memory was noted to be impaired, but also to be
satisfactory. He had good insight and judgment as to his
condition. After examination, the diagnosis was alcohol
dependence and alcohol abuse.
The report of an April 1996 VA examination for mental
disorders noted a history of marijuana use since serving in
Vietnam. The report indicated that the veteran continued to
abuse alcohol and marijuana. The veteran complained of
intermittent auditory and visual hallucinations, bad dreams
and sleep difficulties, but he denied overt suicidal conduct.
He reported that he received Social Security benefits for
alcohol abuse. After examination, the diagnosis was active
alcohol and marijuana abuse.
The veteran testified during a January 1997 hearing regarding
his PTSD claim, including about his claimed stressors and
PTSD symptomatology.
In July 1997 the veteran was hospitalized in a VA post-
traumatic stress disorder program. On mental status
examination he presented with a restricted affect and
dysphoric mood. Speech was coherent with normal range and
rhythm and thinking was focused. He demonstrated recent
memory loss and his insight was moderate. He reported
homicidal ideation but no plan. The Axis I diagnosis
included "X" PTSD; alcohol dependence in early remission;
and marijuana dependence, continuous.
The report of an August 1998 VA examination for PTSD
evaluation noted that due to alcohol dependence, the veteran
had been receiving Social Security disability benefits, which
had been recently lost. The veteran reported complaints of
flashbacks, depression, and intrusive thoughts, which were
attributed as being due to specified traumatic experiences
during his Vietnam service. He related that he felt low self
worth and was depressed as he was not doing anything, and he
did not feel hopeful about the future. He indicated that he
smoked marijuana two to three times per day, but denied
alcohol use since 1997. He denied any suicidal or homicidal
ideations, or any mood swings, manic symptoms, or symptoms
suggestive of generalized anxiety disorder or panic attacks.
The report noted that the veteran was in Vietnam between 1968
and 1969. The veteran reported that during service he was a
gunner involved in combat, and was hurt by shrapnel to the
thigh.
On mental status examination, the veteran was pleasant and
looked somewhat amused about the interview. He exhibited no
motor agitation, and did not have any formal thought
disorder. His affect was noted to be of a normal range and
intensity, and euthymic. He had no suicidal or homicidal
ideations. The report indicated that the veteran did not
have any psychotic symptoms. The assessments were depressive
disorder, not otherwise specified, secondary to long history
of alcohol dependence and continuous marijuana abuse; alcohol
dependence, in remission; and marijuana dependence, in
continuous use. The report noted in a concluding formulation
that it appeared that the veteran was exposed in Vietnam to
traumatic events, which were outside the realm of normal
human experience. The report noted that the veteran had
symptoms of PTSD with nightmares, intrusive thoughts,
isolation, depressive symptoms, symptoms of avoidance, but
did not appear to have symptoms of hyperarousal and did not
meet the full criteria of PTSD. The report further noted
that the veteran had a long history of alcohol dependence,
and indicated that a lot of the veteran's social and
occupational impairment was likely to be secondary to the
alcohol dependence and marijuana dependence.
VA may pay compensation for "disability resulting from
personal injury or disease contracted in line of duty, or for
aggravation of a preexisting injury suffered or disease
contracted in line of duty, in the active military, naval, or
air service." 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303.
Additionally, service connection for PTSD is governed by 38
C.F.R. § 3.304(f), which requires the presentation of
"medical evidence establishing a clear diagnosis of the
condition, credible supporting evidence that the claimed
inservice stressor actually occurred, and a link, established
by medical evidence, between current symptomatology and the
claimed inservice stressor." At a minimum, a 'clear
diagnosis' should be an 'unequivocal' medical opinion of a
current PTSD diagnosis. Cohen v. Brown, 10 Vet. App. 128,
139, 140 (1997). Thus the veteran must submit a "current,
clear medical diagnosis of PTSD," where a clear diagnosis of
PTSD is one that is "unequivocal." Id. at 139.
The veteran has reported that his claimed stressors include
witnessing the death of a soldier who was hit by a sniper's
bullet; being attacked by Vietcong while on night perimeter
defense, when two of the enemy were killed and later disposed
of; and being wounded by grenade shrapnel in his right thigh.
His service medical records show treatment for a shrapnel
wound of the upper right leg, and his service administrative
records show that he served in Vietnam as a field artillery
crewman, and that his decorations include a Vietnam Service
Medal, a Vietnam Campaign Medal, and the Purple Heart. On
this basis, the Board concedes that the veteran experienced
stressors of the type to precipitate PTSD.
However, in this case, the evidence of record does not
demonstrate that the veteran currently has PTSD. As noted
above, one requirement for service connection for PTSD is a
current, clear medical diagnosis of PTSD. Cohen v. Brown, 10
Vet. App. 128 (1997). The examiner who conducted the most
recent VA compensation examination, in August 1998, opined
that while the veteran had some symptoms of PTSD, including
nightmares, intrusive thoughts, isolation, depressive
symptoms, and symptoms of avoidance, the veteran did not
appear to have symptoms of hyperarousal and did not meet the
full criteria of PTSD. That report also noted the veteran's
long history of alcohol dependence, and indicated that much
of the social and occupational impairment was likely to be
secondary to alcohol and marijuana dependence. Moreover, the
report of the August 1998 VA examination shows that the
veteran was assessed as having a depressive disorder, not
otherwise specified, secondary to a long history of alcohol
dependence and continuous marijuana abuse. No other
psychiatric impairment was noted aside from his ongoing
substance dependence difficulties. This comports with other
previous clinical evidence showing that alcohol and drug
abuse were significant causes of symptomatology, and the
focus of treatment.
The Board does acknowledge the apparent diagnosis of PTSD
during VA hospitalization during treatment from August to
October 1992, and treatment in July 1997. However, the 1992
hospital report indicates that the veteran's reported
symptoms were not well understood by the examiner. Moreover
both of these evaluations contrast with reports of VA
examinations in October 1995 and April 1996 for the specific
purpose of evaluating mental disorders. These examination
reports contain diagnoses relating to alcohol and drug abuse,
and do not contain a diagnosis of PTSD. Again, the report of
the most recent examination, by VA in August 1998, indicates
that the scope and severity of symptomatology does not meet
the full criteria of PTSD. That examination was conducted by
an examiner who had access to and reviewed the veteran's
claims file. That examination specifically addressed the
issue of whether the veteran's symptomatology met the
criteria for a diagnosis of PTSD. Accordingly, in the
absence of a current, unequivocal PTSD diagnosis, the Board
concludes that service connection for PTSD is not warranted.
See Cohen, 128 Vet. App. at 138-139.
In reaching this decision the Board carefully considered the
veteran's own opinion that he has PTSD, which is related to
his military service. However, as a lay person, he is not
competent to offer an opinion which requires specialized
knowledge and training. Espiritu v. Derwinski, 2 Vet. App.
492 (1992).
Finally, in reaching this decision the Board also considered
the doctrine of reasonable doubt, however, as the
preponderance of the evidence is against the veteran's claim,
the doctrine is not for application. Gilbert v. Derwinski, 1
Vet. App. 49 (1990).
ORDER
Service connection for PTSD is denied.
WAYNE M. BRAEUER
Member, Board of Veterans' Appeals